Embora a velhice seja uma realidade biológica, os significados que lhe são atribuídos são construções sociais e históricas e se constitui em categoria de análise complexa e heterogênea. O aumento de casos de HIV/Aids entre pessoas acima de 60 anos e adultos tem sido reportado por pesquisadores e tido ampla repercussão na mídia, pois os dados mostram o aumento de casos proporcionais de HIV/Aids entre idosos e adultos comparado as outras faixas de idade. Entre as razões para esse aumento figuram a maior oferta de fármacos contra disfunção erétil, o baixo uso de preservativos nessa geração e o atraso no diagnóstico. A velhice é cercada por uma série de preconceitos e estereótipos (ageism) em razão da idade ou geração e o HIV/Aids nessa fase da vida gera perplexidade, pois rompe com o estereótipo da velhice como uma fase marcada pela assexualidade, recolhimento e passividade. O objetivo deste trabalho foi o de apresentar experiências de pessoas acima de 60 anos convivendo com HIV/Aids em uma cidade histórica de Minas Gerais, colocando em cena dois aspectos pouco estudados, que iluminam duas dinâmicas importantes da epidemia: a interiorização e o aumento dos casos em pessoas nessa faixa etária. A pesquisa foi realizada principalmente a partir de entrevistas com mulheres e homens, acima de 60 anos que eram acompanhados no Centro de Testagem e Aconselhamento em DST/aids (CTA) e com diagnóstico sorológico positivo para o HIV/aids. Participaram da pesquisa três mulheres e um homem, com idades variando entre 60 e 76 anos, com pouca escolaridade, renda e com um tempo de diagnóstico variando de 5 a 9 anos. As entrevistas foram gravadas e transcritas e os conteúdos foram submetidos à análise de conteúdo. A análise dos resultados mostra diferentes estratégias adotadas para o enfrentamento da questão do viver com HIV/Aids, sendo a principal delas a tática do silêncio, do segredo e da ocultação da condição de pessoa convivendo com HIV/Aids, como forma de evitar ainda mais as situações de estigma e discriminação que ocorrem de maneira mais evidente nas relações familiares e na vida cotidiana por meio de diversos constrangimentos. Um aspecto específico do conviver com HIV/Aids nessa fase da vida é o agravamento da diminuição gradual da rede de relações sociais freqüente entre os idosos. Este trabalho mostra que as dimensões sociais de vulnerabilidade, especialmente a pobreza, as desigualdades de gênero, o estigma e a discriminação marcam a experiência de conviver com HIV/Aids na velhice. A superação de tais dimensões constitui-se em processo histórico de transformações amplas nas estruturas sociais, políticas e econômicas, nas relações sociais de gênero e na desconstrução de preconceitos e estigmas. / Although old age is a biological reality, the meanings ascribed to it are social and historical constructions and constitute a complex and heterogeneous analysis category. Increase in HIV/AIDS cases among people over 60 years old and adults has been reported by researchers, gaining wide repercussion in media, since data show a proportional increase in HIV/AIDS cases among elders and adults compared to other age brackets. Amongst the reasons for such increase are: a greater supply of medicines for erectile dysfunction, low use of condoms in such generation, and delayed diagnosis. Old age is surrounded by a number of prejudices and stereotypes (ageism) because of age or generation and HIV/AIDS in such period of life causes perplexity, since it breaks with the stereotype of old age as a period characterized by asexuality, withdrawal, and passiveness. The purpose of this project was to present experiences of people over 60 years old who live with HIV/AIDS in a historical city in Minas Gerais, drawing the attention to two aspects that have little investigation, lighting up two important dynamics of epidemic: internalization and increase in cases of people in such age bracket. The research has been carried out mainly from interviews with women and men over 60 years old who were followed up at DST/AIDS Testing and Counseling Center (CTA) and had HIV/AIDS-positive serological diagnosis. Three women and one man aged between 60 and 76 years old, with little education, income, and diagnosis time varying from 5 to 9 years have participated in the research. The interviews have been recorded and transcribed, and the contents have been submitted to analysis. The analysis of the results shows different strategies used for confrontation of the matter of living with HIV/AIDS, and the main one is the tactic of silence, secrecy and concealment of the condition of persons living with HIV/AIDS as a way to avoid even more stigma and discrimination situations that occur more evidently in family relationships and daily life through several constraints. A specific aspect of living with HIV/AIDS in such period of life is the aggravation of social relationships network fading, often among elders. This project demonstrates that the social dimensions of vulnerability, especially poverty, gender inequalities, stigma and discrimination define the experience of living with HIV/AIDS in old age. Overcoming these dimensions is a historical process of wide transformations in social, political, and economic structures, in gender social relationships, and in the deconstruction of prejudices and stigmas.

Stigma and discrimination are now recognised as major factors in the spread of Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS). To date, research has focused on how to change individual responses to stigma and discrimination without exploring the social and structural dimensions. Complex community and societal dimensions, such as culture, power and difference need to be explored if progress is to be made in coping with stigma and discrimination. India now has HIV/AIDS prevalence figures to rival sub Saharan Africa. The disease has spread from high-risk populations such as intravenous drug users and commercial sex workers into the general population. Married, monogamous, heterosexual women in slum communities are highly vulnerable. Factors such as caste, class, ethnic group, poverty and social expectations present formidable layers of stigma for these women. They have also faced discrimination since before their birth. HIV/AIDS imposes yet another layer of stigma and discrimination upon their shoulders. The aims of the study were firstly to investigate whether stigma and discrimination existed for these women by documenting and analysing literature on the individual, societal and cultural situation of Indian women living with HIV/AIDS (IWLWHAs). Secondly, the study aimed to identify, evaluate and explore the psychosocial needs and coping strategies of IWLWHAs, to determine the barriers to accessing health services, and describe community perceptions as they were experienced by the participants. / This qualitative research study examined the multiple layers of stigma and discrimination experienced by women infected and affected by HIV/AIDS in a low socio-economic area of Mumbai, India. This was achieved by interviewing women who were benefiting from a home-based service - Positive Living - An integrated home-based care programme for people living with HIV/AIDS under the auspices of the KJ Somaiya Hospital in Mumbai. This programme provides a nutrition and home-based service to the nearby community slums. The conceptual framework used for this study was developed to evaluate the effects of natural disasters such as tsunamis, floods and earthquakes. HIV/AIDS is no less of a tragedy for individuals, families and communities. Within this framework, human capacity or the ability of individuals to cope is linked to social ecology - the relationship between individuals and their community. This dimension overlaps with culture and values. Three other dimensions affect humans - economic status, the environment and living conditions, and physical health. I have developed this framework further to examine threats and strengths which arise from these dimensions, and which affect human resilience. An exploratory case study was considered the most suitable approach to explore these areas, as it permits more sensitivity and richer data, and enhances rigour. In-depth interviews of 45 women in three different age groups, home visits and observations, focus group discussion, key informants, narratives, vignettes and photographs were supported by documentary data collection in triangulation of the data. A reflective journal recorded observations and perceptions in the field during three months in India. / Results from the combined data indicated that IWLWHAs experienced discrimination in their families, communities and health care settings. Fear of future discrimination ensured secrecy which, in turn, prevented them accessing community services which would provide emotional and physical support. A range of reactions was demonstrated by the affected women, half of whom were also infected which added to their burden. Women who could not disclose their condition were extremely isolated, lacked family and community support, feared the future and felt hopeless. Despite their appalling living conditions of poverty, overcrowding, prevalence of disease and pollution, the women displayed a sense of pride, dignity and resilience. Culturally appropriate strategies are necessary to address the lack of education and awareness as only two of the 45 women had any knowledge of HIV/AIDS before their own diagnosis which often followed their husbands' positive status. In addition, the social and cultural dimensions which affect these women have to be explored and examined in order to strengthen the 'shock absorbers' of the family. The community health workers and co-ordinator of the home-based service were vital in providing emotional support and health information to the women. Finally, no change is possible unless men take responsibility for their sexual mores. Policy makers and programmes have to look further for strategies which would engage men in the process to change their attitudes and thus protect vulnerable women and children.

O objetivo desta dissertação é analisar e comparar a linguagem multimodal em campanhas de prevenção HIV/Aids, concentrando-se, principalmente, na perspectiva da Linguística Cognitiva, incorporando a abordagem de fatores regionais, culturais e identitários, implicados na produção dessas campanhas. Para isso, também investigam-se as diretrizes apontadas por modelos de atenção e políticas públicas de saúde no Brasil, em especial ao caso da Aids, e como o marketing social atua na intenção de criar melhores condições de vida para todos, utilizando a publicidade como uma ferramenta de propagação desses conceitos. Nesta pesquisa, são levantadas e analisadas metáforas e metonímias multimodais cujo apelo traz marcas de regionalidades diversas, observando de que forma a linguagem publicitária utiliza esses recursos para provocar reações de natureza atitudinal e comportamental em seu públicoalvo. Para atender a essa proposição, o corpus é formado por oito cartazes e dois outdoors de campanhas publicitárias lançadas em diferentes regiões do país entre 2009 e 2015, passados mais de 30 anos do surgimento da epidemia. A investigação fundamenta-se na Teoria da Metáfora Conceitual, proposta por George Lakoff, Mark Johnson e autores associados, bem como nos estudos sobre multimodalidade, desenvolvidos, especialmente, por Charles Forceville. Através deste estudo, conclui-se que as metáforas/metonímias verbais e visuais evidenciam traços regionais, culturais e identitários, aproximando a linguagem do seu público-alvo e salientando especificidades que acionam o processo perceptivo dos receptores, contribuindo para a eficácia das mensagens que estimulam a mudança de hábitos e comportamentos. / Submitted by Ana Guimarães Pereira (agpereir@ucs.br) on 2015-10-21T17:20:12Z No. of bitstreams: 1 Dissertacao Sheila da Rocha.pdf: 3934207 bytes, checksum: 8b5ff522622d2bcba744140aa72925ed (MD5) / Made available in DSpace on 2015-10-21T17:20:12Z (GMT). No. of bitstreams: 1 Dissertacao Sheila da Rocha.pdf: 3934207 bytes, checksum: 8b5ff522622d2bcba744140aa72925ed (MD5) / The objective of this dissertation is to analyze and compare the multimodal language from campaigns that prevent HIV/AIDS, mainly focusing in the Cognitive Linguistics perspective by incorporating the approach of regional, cultural and identity factors that are present in the production of these campaigns. In view of that, the guidelines indicated by models of care and public health policies in Brazil were investigated, notably in the case of AIDS. The study also evaluates how social marketing works in an attempt to create better living conditions for all through the use of advertising as a tool to help spreading these concepts. In this research, metaphors and multimodal metonymies, hich appeal to several regions with different characteristics, are brought to light and analyzed. This approach method is used to observe how the advertising language uses these features to provoke reactions of attitudinal and behavioral nature on the target audience. In order to meet this proposition, a corpus was built with the use of eight posters and two billboards of advertising campaigns that were spread in different parts of the country between 2009 and 2015, more than 30 years after the emergence of the epidemic. The study is based on the Conceptual Metaphor Theory proposed by George Lakoff, Mark Johnson and associated authors, as well as in studies of multimodality especially developed by Charles Forceville and other authors cited in the course of the analysis. Through this study is possible to conclude that verbal and visual metaphors/metonymies show regional, cultural and identity traces, bringing together the language of the target audience and highlighting specifics that drive the perceptual process of receivers, which contributes to the effectiveness of the messages that stimulate change of habits and behaviors.

A Síndrome da Imunodeficiência Adquirida (AIDS) é doença causada pelo vírus da imunodeficiência humana. Apesar dos benefícios proporcionados pela terapia de supressão viral, algumas doenças como lipodistrofia, doenças cardiovasculares e infertilidade aumentaram a sua prevalência. No paciente com AIDS, considera-se a carga viral e o uso de terapia antirretroviral como possíveis agentes de genotoxicidade. Apesar do espermograma não poder detectar a causa precisa da infertilidade, o mesmo ainda é o exame mais realizado para averiguar a qualidade seminal. Por outro lado, a integridade do DNA do espermatozóide tem sido proposta como um parâmetro adicional de qualidade do sêmen. O ensaio cometa alcalino detecta a genotoxicidade de células germinativas humanas e pode ser usado para demonstrar a capacidade de uma substância interagir com o material genético das células gonadais. O presente estudo incluiu 50 pacientes com AIDS, atendidos no Ambulatório de Infectologia do Município de Caxias do Sul e no Ambulatório da Universidade de Caxias do Sul, sendo analisados dois grupos: usuário de terapia antirretroviral e naive. Realizou-se espermograma e o ensaio cometa alcalino, comparando com o número de linfócitos T CD4+, a carga viral, a idade, etc. Os dados demonstraram que o uso de antirretrovirais reduziu a genotoxicidade espermática, mas não se encontrou correlação com o espermograma. O presente trabalho demonstra que o ensaio cometa alcalino é um método eficiente para mensurar a genotoxicidade espermática dos pacientes portadores do vírus da imunodeficiência adquirida. / Submitted by Ana Guimarães Pereira (agpereir@ucs.br) on 2017-02-10T16:43:52Z No. of bitstreams: 1 Dissertacao Viviane Raquel Buffon.pdf: 1789718 bytes, checksum: f0beb1ba820312cad56cf0055072f96d (MD5) / Made available in DSpace on 2017-02-10T16:43:52Z (GMT). No. of bitstreams: 1 Dissertacao Viviane Raquel Buffon.pdf: 1789718 bytes, checksum: f0beb1ba820312cad56cf0055072f96d (MD5) Previous issue date: 2017-02-10 / The Acquired Immune Deficiency Syndrome (AIDS) is a disease caused by the human immunodeficiency virus. Despite all the benefits provided by the viral suppression therapy, some diseases such as lipodystrophy, heart diseases and infertility increased their prevalence. In patients with AIDS, viral load and anti-retroviral therapy are possible agents for genotoxicity. The World Health Organization guidelines are reference for semen analysis and sperm DNA integrity has been proposed as an additionalparameter for semen quality and a potential predictor of fertility. The alkaline comet assay has the potential to detect genotoxic human germ cells and can be used to demonstrate the ability of a substance or metabolite to interact directly with the genetic material of gonadal cells. The study has included 50 patients with AIDS treated at the Outpatient Center for Infectious Diseases and at the University of Caxias do Sul Clinical Center, evaluated as two groups: one treated with anti-retroviral therapy and the other was a naive group. Semen and sperm genotoxicity were analysed by alkaline comet assay, comparing CD4 cell count, viral load, age and other factors of potential genotoxicity between the two groups. Data showed that the use of any anti-retroviral class has reduced sperm genotoxicity. This study shows that the alkaline comet assay is a eficcientmethod to measure sperm genotoxicity in patients infected with the human immunodeficiency virus.

O objetivo desta dissertação é analisar e comparar a linguagem multimodal em campanhas de prevenção HIV/Aids, concentrando-se, principalmente, na perspectiva da Linguística Cognitiva, incorporando a abordagem de fatores regionais, culturais e identitários, implicados na produção dessas campanhas. Para isso, também investigam-se as diretrizes apontadas por modelos de atenção e políticas públicas de saúde no Brasil, em especial ao caso da Aids, e como o marketing social atua na intenção de criar melhores condições de vida para todos, utilizando a publicidade como uma ferramenta de propagação desses conceitos. Nesta pesquisa, são levantadas e analisadas metáforas e metonímias multimodais cujo apelo traz marcas de regionalidades diversas, observando de que forma a linguagem publicitária utiliza esses recursos para provocar reações de natureza atitudinal e comportamental em seu públicoalvo. Para atender a essa proposição, o corpus é formado por oito cartazes e dois outdoors de campanhas publicitárias lançadas em diferentes regiões do país entre 2009 e 2015, passados mais de 30 anos do surgimento da epidemia. A investigação fundamenta-se na Teoria da Metáfora Conceitual, proposta por George Lakoff, Mark Johnson e autores associados, bem como nos estudos sobre multimodalidade, desenvolvidos, especialmente, por Charles Forceville. Através deste estudo, conclui-se que as metáforas/metonímias verbais e visuais evidenciam traços regionais, culturais e identitários, aproximando a linguagem do seu público-alvo e salientando especificidades que acionam o processo perceptivo dos receptores, contribuindo para a eficácia das mensagens que estimulam a mudança de hábitos e comportamentos. / The objective of this dissertation is to analyze and compare the multimodal language from campaigns that prevent HIV/AIDS, mainly focusing in the Cognitive Linguistics perspective by incorporating the approach of regional, cultural and identity factors that are present in the production of these campaigns. In view of that, the guidelines indicated by models of care and public health policies in Brazil were investigated, notably in the case of AIDS. The study also evaluates how social marketing works in an attempt to create better living conditions for all through the use of advertising as a tool to help spreading these concepts. In this research, metaphors and multimodal metonymies, hich appeal to several regions with different characteristics, are brought to light and analyzed. This approach method is used to observe how the advertising language uses these features to provoke reactions of attitudinal and behavioral nature on the target audience. In order to meet this proposition, a corpus was built with the use of eight posters and two billboards of advertising campaigns that were spread in different parts of the country between 2009 and 2015, more than 30 years after the emergence of the epidemic. The study is based on the Conceptual Metaphor Theory proposed by George Lakoff, Mark Johnson and associated authors, as well as in studies of multimodality especially developed by Charles Forceville and other authors cited in the course of the analysis. Through this study is possible to conclude that verbal and visual metaphors/metonymies show regional, cultural and identity traces, bringing together the language of the target audience and highlighting specifics that drive the perceptual process of receivers, which contributes to the effectiveness of the messages that stimulate change of habits and behaviors.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A prevalÃncia das infecÃÃes sexualmente transmissÃveis nos adolescentes vem apresentando nÃmeros elevados no que se diz respeito aos casos de contaminaÃÃo pelo HIV. Dentre os fatores que contribuem para o aumento da vulnerabilidade, destaca-se o conhecimento, por vezes inadequado e inconsistente, que se traduz em um aspecto importante na adoÃÃo de medidas preventivas contra o HIV, sendo a escola um importante espaÃo para se investigar que informaÃÃes esses adolescentes possuem sobre essa epidemia. Diante disso, objetivou-se identificar o diagnÃstico de enfermagem Conhecimento Deficiente acerca do HIV/AIDS em adolescentes do sexo masculino. Tratou-se de um estudo descritivo, do tipo transversal, com abordagem quantitativa. A populaÃÃo consistiu de adolescentes, do sexo masculino, de 12 a 18 anos, pertencentes a uma escola pÃblica e uma particular. A amostra foi de 326 estudantes. Os dados foram coletados nos meses de junho e julho de 2008, atravÃs de um questionÃrio contendo os dados relativos à identificaÃÃo do diagnÃstico de enfermagem em estudo. As mÃdias de idade dos alunos foram de 15,25 e 14,52 anos, para aqueles pertencentes Ãs instituiÃÃes pÃblica e privada, respectivamente. A maioria era solteira. O diagnÃstico foi identificado em 97,2% dos pesquisados, sendo o desempenho inadequado em um teste a caracterÃstica definidora mais presente. O desempenho inferior à 80,0% nos indicadores utilizados para a avaliaÃÃo desta foi de 68,4% quanto ao conhecimento sobre os aspectos gerais do HIV/AIDS; 72,1% para as formas de contaminaÃÃo; e as porcentagens referentes ao uso correto do preservativo masculino e Ãs formas de prevenÃÃo foram, respectivamente, de 52,5% e 61,3%. Acerca dos fatores relacionados, encontrou-se, freqÃentemente, a falta de familiaridade com os recursos da informaÃÃo. Dentre os meios citados para a aquisiÃÃo de conhecimento sobre o HIV/ADS, tÃm-se os profissionais de saÃde, as palestras, os hospitais e os professores. Quanto aos recursos procurados, viu-se que as palestras, a internet, os professores e os pais estÃo entre os mais citados. Os amigos foram a opÃÃo de poucos adolescentes. Quanto ao fator relacionado â falta de interesse em aprender - os estudantes que relataram nunca terem buscado informaÃÃo, justificaram tal conduta, principalmente, em virtude da falta de oportunidade, do desinteresse e de nÃo darem importÃncia ao tema. Concluiu-se que as deficiÃncias de conhecimento encontradas relacionaram-se com o uso do termo portador como referÃncia Ãs pessoas soropositivas, a existÃncia de diferenÃas entre estar contaminado e desenvolver ou nÃo a AIDS, a transmissÃo do vÃrus atravÃs do ato sexual com parceiro fixo sem o uso do preservativo, assim como da mÃe contaminada para a crianÃa, da relaÃÃo sexual com penetraÃÃo vaginal e anal sem camisinha, e por meio da doaÃÃo de sangue. Quanto ao uso do condon, as alternativas que apresentaram menor percentual de acertos foram referentes ao uso de lubrificantes, ao acondicionamento e à inserÃÃo. Portanto, as intervenÃÃes de enfermagem, de natureza educativa, devem reforÃar os conhecimentos existentes e priorizar os dÃficits encontrados, de modo a focalizar as aÃÃes de enfermagem para a obtenÃÃo de resultados favorÃveis ao aumento do nÃvel de conhecimento desses adolescentes quanto ao HIV/AIDS. / The prevalence of infections sexually transmitted in adolescents has been presenting high numbers when it comes to the cases of HIV contamination. Among the factors that contribute to the increase of vulnerability the knowledge stands out, sometimes inadequate and inconsistent, what constitutes an important aspect in the adoption of preventive measures against HIV, being the school an important space to investigate what information these adolescents have on this epidemic. Facing this, it was aimed to identify the nursing diagnosis, the deficient knowledge concerning HIV/AIDS in male adolescents. This is a descriptive study of the transversal type with quantitative approach. The population consisted of male adolescents, from 12 to 18 years, of one public school and one private. The sample was composed by 326 students. The data were collected in the months of June and July 2008, through a questionnaire containing the data data referring to the identification of the nursing diagnosis in study. The age averages of the students were of 15.25 and 14.52 years, for thoses in the public and private institutions respectively. Most were single. The diagnosis was identified in 97.2% of the researched, being the inadequate performance in a test the most present defining characteristic. The performance inferior to 80.0% in the indicators used to this evaluation was of 68.4% regarding the knowledge on general aspects of HIV/AIDS; 72.1% to the contamination forms; and the referring percentages to the correct use of the male preservative and the prevention forms were respectively 52.5% and 61.3%. Concerning the referring factors it was frequently found the lack of familiarity with the information resources. Among the means mentioned to the knowledge acquisition on HIV/AIDS, we have the health professionals, the lectures, the hospitals and the teachers. About the searched resources, it was seen that the lectures, the internet, the teachers and the parents are among the most mentioned. The friends were the option of few adolescents. Regarding the referring factor - lack of interest in learning - the students that told never had looked for information justified such conduct mainly because of the lack of opportunity, indifference and because they donât give importance to the theme. It was concluded that the knowledge deficiencies found were related with the use of the term bearer as reference to the soropositives, the existence of differences between being contaminated and develop or not AIDS, the virus transmission through the sexual act with only one partner without the use of preservative, as well as the contaminated mother to the child, the sexual relationship with vaginal and anal penetration without condom, and through blood donation. About the use of condom, the alternatives that presented smaller percentage of success were referring to the use of lubricants, the storage and the insertion. Therefore, the nursing interventions of educational nature should reinforce the existent knowledge and give priority the found deficits, in a way to focus the nursing actions in the acquisition of favorable results to increase the knowledge of these adolescents regarding HIV/AIDS.

Embora a velhice seja uma realidade biológica, os significados que lhe são atribuídos são construções sociais e históricas e se constitui em categoria de análise complexa e heterogênea. O aumento de casos de HIV/Aids entre pessoas acima de 60 anos e adultos tem sido reportado por pesquisadores e tido ampla repercussão na mídia, pois os dados mostram o aumento de casos proporcionais de HIV/Aids entre idosos e adultos comparado as outras faixas de idade. Entre as razões para esse aumento figuram a maior oferta de fármacos contra disfunção erétil, o baixo uso de preservativos nessa geração e o atraso no diagnóstico. A velhice é cercada por uma série de preconceitos e estereótipos (ageism) em razão da idade ou geração e o HIV/Aids nessa fase da vida gera perplexidade, pois rompe com o estereótipo da velhice como uma fase marcada pela assexualidade, recolhimento e passividade. O objetivo deste trabalho foi o de apresentar experiências de pessoas acima de 60 anos convivendo com HIV/Aids em uma cidade histórica de Minas Gerais, colocando em cena dois aspectos pouco estudados, que iluminam duas dinâmicas importantes da epidemia: a interiorização e o aumento dos casos em pessoas nessa faixa etária. A pesquisa foi realizada principalmente a partir de entrevistas com mulheres e homens, acima de 60 anos que eram acompanhados no Centro de Testagem e Aconselhamento em DST/aids (CTA) e com diagnóstico sorológico positivo para o HIV/aids. Participaram da pesquisa três mulheres e um homem, com idades variando entre 60 e 76 anos, com pouca escolaridade, renda e com um tempo de diagnóstico variando de 5 a 9 anos. As entrevistas foram gravadas e transcritas e os conteúdos foram submetidos à análise de conteúdo. A análise dos resultados mostra diferentes estratégias adotadas para o enfrentamento da questão do viver com HIV/Aids, sendo a principal delas a tática do silêncio, do segredo e da ocultação da condição de pessoa convivendo com HIV/Aids, como forma de evitar ainda mais as situações de estigma e discriminação que ocorrem de maneira mais evidente nas relações familiares e na vida cotidiana por meio de diversos constrangimentos. Um aspecto específico do conviver com HIV/Aids nessa fase da vida é o agravamento da diminuição gradual da rede de relações sociais freqüente entre os idosos. Este trabalho mostra que as dimensões sociais de vulnerabilidade, especialmente a pobreza, as desigualdades de gênero, o estigma e a discriminação marcam a experiência de conviver com HIV/Aids na velhice. A superação de tais dimensões constitui-se em processo histórico de transformações amplas nas estruturas sociais, políticas e econômicas, nas relações sociais de gênero e na desconstrução de preconceitos e estigmas. / Although old age is a biological reality, the meanings ascribed to it are social and historical constructions and constitute a complex and heterogeneous analysis category. Increase in HIV/AIDS cases among people over 60 years old and adults has been reported by researchers, gaining wide repercussion in media, since data show a proportional increase in HIV/AIDS cases among elders and adults compared to other age brackets. Amongst the reasons for such increase are: a greater supply of medicines for erectile dysfunction, low use of condoms in such generation, and delayed diagnosis. Old age is surrounded by a number of prejudices and stereotypes (ageism) because of age or generation and HIV/AIDS in such period of life causes perplexity, since it breaks with the stereotype of old age as a period characterized by asexuality, withdrawal, and passiveness. The purpose of this project was to present experiences of people over 60 years old who live with HIV/AIDS in a historical city in Minas Gerais, drawing the attention to two aspects that have little investigation, lighting up two important dynamics of epidemic: internalization and increase in cases of people in such age bracket. The research has been carried out mainly from interviews with women and men over 60 years old who were followed up at DST/AIDS Testing and Counseling Center (CTA) and had HIV/AIDS-positive serological diagnosis. Three women and one man aged between 60 and 76 years old, with little education, income, and diagnosis time varying from 5 to 9 years have participated in the research. The interviews have been recorded and transcribed, and the contents have been submitted to analysis. The analysis of the results shows different strategies used for confrontation of the matter of living with HIV/AIDS, and the main one is the tactic of silence, secrecy and concealment of the condition of persons living with HIV/AIDS as a way to avoid even more stigma and discrimination situations that occur more evidently in family relationships and daily life through several constraints. A specific aspect of living with HIV/AIDS in such period of life is the aggravation of social relationships network fading, often among elders. This project demonstrates that the social dimensions of vulnerability, especially poverty, gender inequalities, stigma and discrimination define the experience of living with HIV/AIDS in old age. Overcoming these dimensions is a historical process of wide transformations in social, political, and economic structures, in gender social relationships, and in the deconstruction of prejudices and stigmas.

Magister Artium - MA / Twenty years into democracy and South Africa like many of the world‟s nations still faces manifold challenges in dealing with HIV/AIDS. This disease affects millions of people in various forms; socially, economically and politically. HIV/AIDS is considered to be a global pandemic (UNAIDS, 2011). The largest group at risk appears to be people between the ages of 15 and 24. One crucial way of dealing with this pandemic is through education since the emphasis is on prevention. It is against this background that this study explored the challenges teachers face in implementing HIV and AIDS initiatives and programmes in two primary schools in Crossroads, in the Nyanga region, in the Western Cape. It appears that research on this topic is not normally carried out in primary schools. I therefore start from the premise that literature on the topic, especially in this empirical field (primary schools), is limited. The conceptual lens used to understand this complex issue is the Bio-ecological Systems Model of Bronfrenbrenner (1977). Teachers operate within various contexts and their teaching is often influences by their experiences, knowledge and attitudes (Tayob, 2010:3). Furthermore, it appears that the implementation of HIV/AIDS initiatives and programmes at primary school level is dependent on the relationship between many systems. The complexities of understanding these relationships warrant the use of this model within this study. Methodologically, this study employed a qualitative case study research design to investigate this contemporary phenomenon. I employed in-depth qualitative data collection procedures which included: a questionnaire, semi-structured interviews, and document analysis. The findings indicate that educators are seriously constrained by lack of support from school management and parents when engaging in HIV/AIDS initiatives or programmes at respective primary schools. The study also reveals that educators are not well trained to offer counselling to deal with HIV/AIDS related matters and it becomes worse with those infected. In addition, this study reveals that embedded cultural beliefs play a huge impeding factor in attempts to participate in HIV/AIDS initiatives and programmes, which are aimed to empower both educators and learners. The study therefore recommends a need for stronger financial muscle and support from schools management team to ensure that time set aside for life orientation classes be utilised effectively for the benefit of learners with priority on HIV/AIDS studies and initiative programmes. A strategic inclusion of parents, religious and traditional leaders with the Department of Basic Education and all relevant partners is very critical to achieve the fight against the struggle with HIV/AIDS through means of education at all levels within the sector and beyond.

Magister Public Health - MPH / In recognition of high dual burden of tuberculosis (TB) and Human Immunodeficiency virus(HIV) in Sub-Saharan Africa, the World Health Organization (WHO, 2004) provided guidance for implementing integrated HIV/TB services. This strategy has been implemented using different models ranging from partial to fully integrating, and evaluations of these models have been conducted to determine their effectiveness. The aim of this study was to describe and contrast the effectiveness of different models of implementation of HIV and TB integration at primary care level within the Tuberculosis (TB) programme in Livingstone District, Zambia The specific objectives of the study included; 1. To describe the models of integrated HIV and TB services that are currently implemented at four health facilities within the TB programme in Livingstone District at primary health care level. 2. To describe and contrast the coverage and quality of HIV diagnosis in the Tuberculosis(TB) programme achieved in the different facilities representing fully and partially integrated models of service delivery. 3. To describe and contrast the coverage and quality of HIV prevention activities in the Tuberculosis (TB) programme achieved in the different health facilities representing fully and partially integrated models of service delivery. 4. To describe and contrast the coverage and quality of HIV care activities received by coinfected clients in the Tuberculosis (TB) programme in the different facilities representing fully and partially integrated models of service delivery. 5. To describe the quality and outcomes of TB diagnosis and treatment in the different facilities representing fully and partially integrated models of service delivery. A research design using quantitative methodologies: a cross sectional survey and structured observations or review of patient records (quantitative) were used. The records of 814 TB clients notified in 2010 served as the study population while the sample of 464 (232 from partially and 232 from fully integrated) were randomly selected. Two data collection tools namely: patient record and HIV/TB register review; facility staff interviews (key informant interviews) were used and the results were analyzed using Epi info statistical package. In the study, all respondents gave informed consent and no personal information was collected from the retrospective record review. The HIV prevention interventions in this study were rated below 30% except for of HIV education (97%). Statistically significant differences (p-value<0.001) existed for condom provision at facility level. Poor performance reported for STI screening (below 2%) and PMTCT information (below 15%). The HIV testing rate was 94% among TB clients which was higher than the counseling coverage of 88%. Statistically significant differences (p value <0.001) at facility level existed for clients who received HIV test results. Sixty three percent (63%) of TB clients were also co- infected with HIV. ART assessment for TB clients was below 40% and statistically significant differences (p value=<0.001) between facilities were identified for this indicator. ART assessment of TB clients at the same facility they tested for HIV was above 50% for all facilities. The continuation of cotrimoxazole was poor at 38% and statistically significant differences (p value=<0.001) were identified for this indicator between facilities. Sputum testing was 85% while the cure rate was poor at 28% average for all facilities. Statistically significant differences (p-<0.001) were noticed at model level for clients cured. Although HIV prevention and care services were introduced in the TB program in Livingstone,they were not comprehensive enough to respond to the high HIV and TB co-infectivity. For HIV prevention, other than HCT and HIV education, the rest of the critical interventions such as condom provision, STI screening and treatment, and PMTCT intervention were neglected. The HIV care services such as ART assessment and CPT implementation were also poor. There is need to put in place systems to improve these services in the district to improve treatment outcomes. The differences that were noted in performance for the majority of the indicators were mainly at facility level as being a fully integrated facility did not guarantee effective integration or better performance.

Magister Public Health - MPH / Background: The hallmark of HIV infection is immunosuppression which predisposes to unusual infections and malignancies generally known as opportunistic diseases (ODs). Globally, ODs are the major cause of morbidity and mortality in people living with HIV (PLHIV). Since the advent of Highly Active Antiretroviral Therapy (HAART), a significant decline in AIDS progression and ODs has been observed globally. However, most of the evidence suggesting sustained decline in AIDS progression and ODs has come from high-income settings with relatively less burden of ODs in the pre-HAART era. The findings of studies in high-income settings may not be generalizable to resource-limited settings. Lack of information regarding the burden of ODs in HAART-experienced populations in Nigeria and the risk factors for their occurrence has made it difficult to fully assess the sustained efficacy of HAART in the country. The aim of this study was to investigate the prevalence of and risk factors for HIV-related opportunistic diseases amongst HAART patients at the Federal Medical Centre (FMC) in Owerri, Nigeria. Study design and setting: A quantitative, cross-sectional descriptive and analytical study was conducted with 354 adult HIV-infected patients 15 years and above, who were on HAART for a minimum of 12 weeks at the HIV clinic of the FMC, Owerri, South-east Nigeria. Patients currently manifesting an OD whose onset ante-dated the commencement of HAART were excluded. The participants were recruited by simple random sampling. Data collection: Using a structured questionnaire, data was collected by clinicians through interviews, physical and laboratory examinations for patients that provided informed consent and met the study criteria. The questionnaire captured patient’s socio-demographic information and other relevant clinical/laboratory data. Data Analysis: The data was analysed using Epi info version 3.5.1 and Open Epi Version 2.2.1. Descriptive statistics for HIV-related ODs were carried out using percentages and frequencies tables for categorical variables and means (SD) or medians (IQR) for numerical variables. In univariate analysis, the Chi-square test was used to determine significance of association between OD and socio-demographic and clinical variables while the Student "t"-test was used to compare group means. Logistic regression model (multivariate analysis) was used to determine the independent risk factors for the occurrence of ODs using parameters that had a p-value of <0.25 on univariate analysis. All reported p-values <0.05 were considered statistically significant. Results: The mean age of the participants was 41.1 ± 10.0 years; and females were in the majority (65.8%). Over 40% of them were rural dwellers, 50.4% belonged to the lower socioeconomic class, and 55% had a monthly household income less than 20,000 Naira. Fifty percent (50%) of them had advanced immunosuppression at first presentation. The median duration of HAART (3 years) paralleled the median duration of HIV diagnosis (3.4 years) and HAART adherence rate was 78%. The overall prevalence of ODs was found to be 22.4%. Among the 76 patients diagnosed with ODs, the leading conditions were candidiasis (38.2%), TB (34.2%), dermatitis (25%), chronic diarrhoea (6.6%) and sepsis (6.6%). The independent risk factors for the occurrence of ODs were household income less than 20,000 Naira (Adjusted odds ratio [AOR] = 2.4, 95% CI 1.1-5.1), HIV duration of less than 3 years (AOR= 2.1, 95% CI 1.1- 4.2), advanced WHO clinical stage at baseline (AOR= 8.1, 95% CI 4.0-16.4), baseline haemoglobin less than 10 g/dl (AOR= 2.9, 95% CI 1.3-56.1), current CD4 cell count less than 200 cells/μl (AOR= 3.0, 95% CI 1.14-6.2), and HAART non-adherence (AOR= 5.4, 95% CI 2.6-11.2). Past history of TB was found to be a strong predictor of TB (AOR= 5.3, 95% CI 1.4-20.2). Conclusions: Opportunistic diseases are common in patients receiving HAART in Nigeria and candidiasis and TB remain the leading conditions. Late presentation and HAART non-adherence are among the strongest risk factors for ODs in patients receiving HAART. Others include duration of HIV diagnosis less than 3 years, presence of anaemia at the time of first presentation and having a low CD4 cell count while on HAART. Beyond these clinical risk factors, poverty increases the risk of developing an OD during HAART and may emerge a strong determinant of HIV-related ODs in developing countries. Recommendations: A high index of suspicion for ODs remains necessary in HAART patients. Health education on HIV screening and early presentation should be intensified. PLHIV who are anaemic before commencement of HAART, those with low CD4 cell count despite HAART use, and low-income earners should become target groups for a more aggressive evaluation for ODs. Prophylaxis for TB and fungal infections in the absence of active disease should be widely implemented in developing countries. HAART adherence should be intensified.